BACKGROUND & AIMS: OBJECTIVE:To determine the diagnostic value of fetal ST-segment analysis (STAN) in predicting neonatal acidosis. METHODS:The STAN S21 was used to monitor singleton fetuses in labor with abnormal FHR. Physicians later reviewed tracings to identify any ST events dictating intervention. Outcome measures were umbilical artery pH< or =7.15 and pH< or =7.05 at birth. The sensitivity, specificity, PPV, and NPV of a significant ST event to predict both outcomes were calculated. RESULTS:Analysis included 411 women. Sensitivity of a significant ST event for screening pH< or =7.15 (21.9%) was 38% (41/108), specificity 83% (252/303), PPV 45% (41/92) and NPV 79% (252/319), and for pH< or =7.05, it was (3.4%), 62.5% (10/16), 79% (313/395), 11% (10/92), and 98% (313/319), respectively. CONCLUSION:In a population with abnormal FHR in labor, STAN sensitivity is moderate (almost 40%) for predicting pH< or =7.15 and better (almost 60%) for more severe acidosis (pH< or =7.05).

背景与目标： 目的：确定胎儿ST段分析（STAN）对预测新生儿酸中毒的诊断价值。
方法：STAN S21用于监测胎心率异常的单胎胎儿。内科医生随后检查了示踪剂，以发现任何指示干预的ST事件。结果测量是出生时脐动脉pH <或= 7.15和pH <或= 7.05。计算了可预测两种预后的重大ST事件的敏感性，特异性，PPV和NPV。
结果：分析包括411名妇女。筛查pH <或= 7.15（21.9％）的重大ST事件的敏感性为38％（41/108），特异性83％（252/303），PPV 45％（41/92）和NPV 79％（252 / 319），对于pH <或= 7.05，分别为（3.4％），62.5％（10/16），79％（313/395），11％（10/92）和98％（313/319） ， 分别。
结论：在FHR异常的人群中，STAN对预测pH <或= 7.15的敏感性为中度（近40％），对更严重的酸中毒（pH <或= 7.05）的敏感性为（近60％）。

BACKGROUND & AIMS: BACKGROUND:The primary aim of this study is to understand more about the perceptual-cognitive mechanisms underpinning the expert advantage in electrocardiogram (ECG) interpretation. While research has examined visual search processes in other aspects of medical decision making (e.g., radiology), this is the first study to apply the paradigm to ECG interpretation. The secondary aim is to explore the role that clinical history plays in influencing visual search behavior and diagnostic decision making. While clinical history may aid diagnostic decision making, it may also bias the visual search process. METHODS:Ten final-year medical students and 10 consultant emergency medics were presented with 16 ECG traces (8 with clinical history that was not manipulated independently of case) while wearing eye tracking equipment. The ECGs represented common abnormalities encountered in emergency departments and were among those taught to final-year medical students. Participants were asked to make a diagnosis on each presented trace and report their level of diagnostic confidence. RESULTS:Experts made significantly faster, more accurate, and more confident diagnoses, and this advantage was underpinned by differences in visual search behavior. Specifically, experts were significantly quicker at locating the leads of critical importance. Contrary to our hypothesis, clinical history had no significant effect on the readers' ability to detect the abnormality or make an accurate diagnosis. CONCLUSIONS:Accurate ECG interpretation appears dependent on the perceptual skill of pattern recognition and specifically the time to fixate the critical lead(s). Therefore, there is potential clinical utility in developing perceptual training programs to train novices to detect abnormalities more effectively.

背景与目标： 背景：本研究的主要目的是更多地了解心电图（ECG）解释专家优势的知觉-认知机制。尽管研究已经在医学决策的其他方面（例如放射学）研究了视觉搜索过程，但这是首次将范例应用于ECG解释的研究。第二个目的是探讨临床病史在影响视觉搜索行为和诊断决策中的作用。尽管临床病史可能有助于诊断决策，但也可能会偏向视觉搜索过程。
方法：在佩戴眼动追踪设备的情况下，向10名最后一年的医学生和10名急诊医学顾问提供了16条ECG痕迹（其中8条的临床病史并未独立于病例进行操作）。心电图代表急诊科遇到的常见异常情况，并且是针对最后一年的医学生教授的心电图。要求参与者对每个显示的迹线进行诊断，并报告他们的诊断信心水平。
结果：专家做出了更快，更准确和更自信的诊断，并且这一优势得到了视觉搜索行为差异的支持。具体来说，专家在查找至关重要的线索方面要快得多。与我们的假设相反，临床病史对读者发现异常或做出准确诊断的能力没有重大影响。
结论：正确的心电图解释取决于模式识别的感知技能，尤其是固定关键导线的时间。因此，在开发知觉训练程序以训练新手更有效地检测异常方面有潜在的临床效用。

BACKGROUND & AIMS: RATIONALE:The De Winter electrocardiogram (ECG) pattern is considered as a ST elevated myocardial infarction (STEMI)-equivalent pattern. Due to its rare nature, it is unclear whether this ECG pattern suggests the presence of some other condition. PATIENT CONCERNS:We reported a 47-year-old man with new-onset chest discomfort several hours after the second-stage percutaneous coronary intervention (PCI). DIAGNOSES:An emergency coronary angiogram (CAG) did not show any abnormality. However, the dynamic changes in the ECG and myocardial biomarkers indicated perioperative myocardial infarction. INTERVENTION:The patient was monitored in the cardiac care unite (CCU), and was administered an intravenous infusion of diltiazem and subcutaneous injection of low molecular weight heparin. OUTCOMES:After a few hours, his symptoms were alleviated. The patient was discharged after 6 days of hospitalization without any complications. LESSONS:The De Winter ECG pattern can be observed in patients without significantly coronary arteries occlusion. The newly onset De Winter ECG pattern after PCI procedure may indicate perioperative myocardial infarction caused by impaired microvascular perfusion.

背景与目标： 理由：De Winter心电图（ECG）模式被认为是ST升高的心肌梗死（STEMI）等效模式。由于其罕见的性质，目前尚不清楚这种ECG模式是否暗示存在某些其他情况。
患者的担忧：我们报告了一名47岁的男性，在第二阶段经皮冠状动脉介入治疗（PCI）后数小时内出现新发的胸部不适。
诊断：紧急冠状动脉造影（CAG）未显示任何异常。然而，心电图和心肌生物标志物的动态变化表明围手术期心肌梗塞。
干预：患者在心脏监护病房（CCU）进行了监测，并接受了地尔硫卓的静脉输注和低分子量肝素的皮下注射。
结果：几个小时后，他的症状得到缓解。住院6天后出院，无任何并发症。
教训：在没有明显冠状动脉闭塞的患者中可以观察到De Winter ECG模式。 PCI手术后新近发生的De Winter ECG模式可能表明微血管灌注受损导致围手术期心肌梗塞。

BACKGROUND & AIMS: BACKGROUND:Non-invasive fetal electrocardiogram (NIFECG) is an evolving technology in fetal surveillance which is attracting increasing research interest. There is however, only limited data outlining the reference ranges for normal cardiac time intervals (CTIs). The objective of our group was to carry out a systematic review to outline normal fetal CTIs using NIFECG. METHODS:A systematic review of peer reviewed literature was performed, searching PUBMED,Ovid MEDLINE and EMBASE. The outcomes of interest included fetal CTIs (P wave duration, PR interval, QRS duration and QT interval) and a descriptive summary of relevant studies as well. The outcomes were grouped as early pre-term (≤ 32 weeks), moderate to late pre-term (32-37 weeks) and term (37-41 weeks). RESULTS:8 studies were identified as suitable for inclusion. Reference ranges of CTIs were generated. Both PR interval and QRS duration demonstrated a linear correlation with advancing gestation. Several studies also demonstrated a reduction in signal acquisition between 27 and 32 weeks due to the attenuation by vernix caseosa. In this group, both the P wave and T waves were difficult to detect due to signal strength and interference. CONCLUSION:NIFECG demonstrates utility to quantify CTIs in the fetus, particularly at advanced gestations. Larger prospective studies should be directed towards establishing reliable CTIs across various gestations.

背景与目标： 背景：无创胎儿心电图（NIFECG）是一种在胎儿监护中不断发展的技术，正引起越来越多的研究兴趣。但是，只有有限的数据概述了正常心脏时间间​​隔（CTI）的参考范围。我们小组的目的是对使用NIFECG进行的正常胎儿CTI进行系统的综述。
方法：对同行评审文献进行系统综述，检索PUBMED，Ovid MEDLINE和EMBASE。感兴趣的结果包括胎儿CTI（P波持续时间，PR间隔，QRS持续时间和QT间隔）以及相关研究的描述性摘要。结果分为早产期（≤32周），中至早产期（32-37周）和足月期（37-41周）。
结果：确定了8项适合纳入的研究。生成了CTI的参考范围。 PR间期和QRS持续时间均与妊娠进展呈线性相关。几项研究还表明，由于酪蛋白感染的衰减，信号采集在27至32周之间减少了。在该组中，由于信号强度和干扰，P波和T波均难以检测。
结论：NIFECG证明了定量胎儿中CTI的实用性，尤其是在晚期妊娠时。较大的前瞻性研究应针对在各种妊娠中建立可靠的CTI。

BACKGROUND & AIMS: BACKGROUND:Transcutaneous cardiac pacing (TCP) is deeply entwined with the problem of assessing ventricular capture on the electrocardiogram (ECG). We sought clarification of ventricular capture during TCP. METHODS:We studied one hundred and ten patients (75 ± 12 years) with bradycardia who underwent pacemaker or implantable cardioverter-defibrillator implantation. The cohort was stratified by structural heart disease (SHD) status and presence of narrow or wide QRS during spontaneous heart rhythm. We compared 12-lead ECG data at baseline (48 ± 7 beats/min) with those of TCP as well as of transvenous pacing (TVP) at a similar increased heart rate (76 ± 9 beats/min) to ensure constant ventricular capture. The QT interval was corrected for heart rate (QTc) using Bazett's method as well as by the Hodge's and Rautaharju's formulae depending on the presence of narrow or wide QRS at baseline. Electromechanical coupling was assessed by noninvasive arterial pressure measurement. RESULTS:TCP (median 80 mA) produced a QRS pattern resembling left bundle branch block. Overall, both TCP and TVP induced significant QRS and QTc prolongations when compared with baseline measures (p < 0.001). TCP created narrower QRS than TVP in those patients with SHD and narrow QRS (p < 0.006). There was no significant QTc duration difference between TCP and TVP. Mean arterial pressure underwent similar significant decrease following either TCP or TVP over baseline (p < 0.001), without difference between the two pacing approaches in any patient group. CONCLUSION:TCP is associated with similar ECG and hemodynamic responses to those of TVP, regardless of the presence of SHD.

背景与目标： 背景：经皮心脏起搏（TCP）与评估心电图（ECG）上的心室捕获问题紧密相关。我们寻求澄清TCP期间的心室捕获。
方法：我们研究了110例（75±12岁）的心动过缓患者，这些患者接受了起搏器或可植入的心脏复律除颤器植入术。该队列按结构性心脏病（SHD）的状态以及自发性心律期间存在窄或宽QRS进行分层。我们将基线时的12导联心电图数据（48±7次/分钟）与TCP以及静脉起搏（TVP）的心率（76±9次/分钟）进行了比较，以确保恒定的心室捕获。使用基线的窄或宽QRS，使用Bazett方法以及Hodge和Rautaharju公式对QT间隔的心率（QTc）进行校正。机电耦合通过无创动脉压测量进行评估。
结果：TCP（中值80 mA）产生了类似于左束支传导阻滞的QRS模式。总体而言，与基线指标相比，TCP和TVP均引起显着的QRS和QTc延长（p <0.001）。在SHD和QRS狭窄的患者中，TCP产生的QRS较TVP狭窄（p <0.006）。 TCP和TVP之间没有显着的QTc持续时间差异。 TCP或TVP后，平均动脉压经历了类似的显着下降（p <0.001），在任何患者组中两种起搏方法之间没有差异。
结论：TCP与TVP具有相似的心电图和血流动力学反应，无论是否存在SHD。

BACKGROUND & AIMS: :Baseline wandering in electrocardiogram (ECG) is one of the biggest interferences in visualization and computerized detection of waveforms (especially ST-segment) based on threshold decision. A new method based on wavelet transform, QRS barycenter fitting and regional method was proposed in this paper. Firstly, wavelet transform as a coarse correction was used to remove the baseline wandering, whose frequency bands were non-overlapping with that of ST-segment. Secondly, QRS barycenter fitting was applied as a detailed correction. The third, the regional method was used to transfer baseline to zero. Finally, the method in this paper was proved to perform better than filtering and function fitting methods in baseline wandering correction after the long-term ST database (LTST) verification. In addition, the proposed method is simple and easy to carry out, and in current use.

背景与目标： ：心电图基线漂移（ECG）是基于阈值决策的波形（尤其是ST段）的可视化和计算机检测中的最大干扰之一。提出了一种基于小波变换，QRS重心拟合和区域方法的新方法。首先，使用小波变换作为粗略校正来消除基线漂移，基线漂移的频带与ST段的频带不重叠。其次，应用QRS重心拟合作为详细校正。第三，使用区域方法将基线转换为零。最后，经长期ST数据库（LTST）验证，证明该方法在基线漂移校正中比滤波和函数拟合方法具有更好的性能。另外，所提出的方法简单且易于实施，并且在当前使用。

BACKGROUND & AIMS: :Although diagnostic assessment and treatment have been described in detail in patients with symptomatic Wolff-Parkinson-White (WPW) syndrome, the management of asymptomatic subjects remains controversial. Usually they are assumed to have a benign prognosis, although they do very occasionally present with ventricular fibrillation (VF) as the first manifestation of the syndrome. Discovering a WPW pattern in a previously asymptomatic athlete on a routine electrocardiogram (ECG) identifies the necessity for more accurate screening tests. However, non-invasive methods (Holter monitoring, exercise treadmill testing) seem to be relatively incomplete for risk stratification, especially for athletes. Current guidelines do not always recommend a routine electrophysiological study (EPS) in patients with an asymptomatic WPW ECG pattern, especially in children younger than 12 years. Individuals who engage in high-risk occupations or those patients who have a pre-excitation pattern which precludes them from following their chosen career or activities may be exceptions. The presence of inducible reciprocating tachycardia during EPS, especially when it triggers atrial fibrillation with short RR interval, can represent a specific risk marker of dangerous arrhythmias.

背景与目标： ：尽管对有症状的沃尔夫-帕金森-怀特（WPW）综合征患者进行了详细的诊断评估和治疗，但无症状患者的治疗仍存在争议。通常认为它们预后良好，尽管偶尔会出现室颤（VF）作为该综合征的首发表现。在常规心电图（ECG）上发现以前没有症状的运动员中的WPW模式可确定进行更准确筛查测试的必要性。但是，对于风险分层，非侵入性方法（动态心电图监测，运动跑步机测试）似乎相对不完整，尤其是对于运动员而言。当前的指南并不总是建议对无症状WPW ECG模式的患者进行常规电生理研究（EPS），尤其是对于12岁以下的儿童。从事高风险职业的个人或具有预激励模式的患者可能会例外，因为这种模式会阻止他们从事自己选择的职业或活动。 EPS期间存在可诱导的往复性心动过速，特别是当它以短的RR间隔触发房颤时，可能是危险性心律失常的特定危险标志。

BACKGROUND & AIMS: BACKGROUND:QT dispersion, maximal interlead difference in QT interval on 12-lead electrocardiogram (ECG), measures cardiac repolarization abnormalities. Data are conflicting whether QT dispersion predicts adverse outcome in acute ischemic stroke (AIS) patients. Our objective is to determine if QT dispersion predicts: (1) short-term clinical outcome in AIS, and (2) stroke location (insular versus noninsular cortex). METHODS:Admission ECGs from 412 consecutive patients with acute stroke symptoms from 2 university-based stroke centers were reviewed. QT dispersion was measured. A neuroradiologist reviewed brain imaging for insular cortex involvement. Favorable clinical outcomes at discharge were modified Rankin Scale (mRS) score of 0-1, discharge National Institutes of Health Stroke Scale (NIHSS) score less than 2, and discharge to home. Multiple logistic regressions were performed for each outcome measure and to determine the association between insular infarct and QT dispersion. RESULTS:Of 145 subjects in the final analysis, median age was 65 years (interquartile range [IQR] 56-75), male patients were 38%, black patients were 68%, median QT dispersion was 78 milliseconds (IQR 59-98), and median admission NIHSS score was 4 (IQR 2-6). QT dispersion did not predict short-term clinical outcome for mRS score (odds ratio [OR] = 1.001, 95% confidence interval [CI] .99-1.01, P = .85), NIHSS at discharge (OR = .994, 95% CI .98-1.01, P = .30), or discharge disposition (OR = 1.001, 95% CI .99-1.01, P = .81). Insular cortex involvement did not correlate with QT dispersion magnitude (OR = 1.009, 95% CI .99-1.02, P = .45). CONCLUSIONS:We could not demonstrate that QT dispersion is useful in predicting short-term clinical outcome at discharge in AIS. Further, the magnitude of QT dispersion did not predict insular cortical stroke location.

背景与目标： 背景：QT离散度是12导联心电图（ECG）上QT间隔的最大导联间差异，可测量心脏复极化异常。数据是否与QT离散度预测急性缺血性卒中（AIS）患者的不良结果相矛盾。我们的目标是确定QT离散度是否预测：（1）AIS的短期临床预后，以及（2）脑卒中的位置（孤立与非孤立皮质）。
方法：回顾性分析了来自2个大学卒中中心的412例急性中风症状的连续患者的入院心电图。测量了QT分散度。一位神经放射科医生审查了大脑成像以了解岛状皮层受累情况。出院时的良好临床结局是改良的兰金量表（mRS）评分为0-1，出院的美国国立卫生研究院卒中量表（NIHSS）得分小于2，并出院回家。对每种结局指标进行了多次逻辑回归分析，并确定了岛梗塞与QT离散度之间的关系。
结果：最终分析的145位受试者中，年龄中位数为65岁（四分位间距[IQR] 56-75），男性患者为38％，黑人患者为68％，QT离散度中位数为78毫秒（IQR 59-98） ，入院NIHSS评分中值为4（IQR 2-6）。 QT离散度不能预测mRS评分的短期临床结果（优势比[OR] = 1.001，95％置信区间[CI] .99-1.01，P = .85），出院时NIHSS（OR = .994，95） ％CI 0.98-1.01，P = .30）或放电处置（OR = 1.001，95％CI 0.99-1.01，P = 0.81）。岛状皮层受累与QT离散度无关（OR = 1.009，95％CI 0.99-1.02，P = 0.45）。
结论：我们无法证明QT离散度可用于预测AIS出院时的短期临床结果。此外，QT离散度不能预测皮层皮质中风的位置。

BACKGROUND & AIMS: BACKGROUND:The aim of this study was to determine the frequency and nature of errors made by computer electrocardiogram (ECG) analysis of atrial fibrillation (AF), and the clinical consequences. HYPOTHESIS:Computer software for interpreting ECGs has advanced. METHODS:A total of 10279 ECGs were collected, automatically interpreted by the built-in ECG software, and then reread by 2 cardiologists. AF-related ECGs were classified into 3 groups: overinterpreted AF (rhythms other than AF interpreted as AF), misinterpreted AF (AF interpreted as rhythms other than AF), and true AF (AF interpreted as AF by both computer ECG interpretation and cardiologists). RESULTS:There were 1057 AF-related ECGs from 409 patients. Among these, 840 ECGs (79.5%) were true AF. Overinterpretation occurred in 98 (9.3%) cases. Sinus rhythm and sinus tachycardia with premature atrial contraction and/or baseline artifact and sinus arrhythmia were commonly overinterpreted as AF. Heart rate ≤60 bpm and baseline artifact significantly increased the likelihood of overinterpreted AF. Misdiagnosis occurred in 119 (11.3%) cases, in which AF was usually misdiagnosed as sinus or supraventricular tachycardia. The presence of tachycardia and low-amplitude atrial activity significantly increased the likelihood of misdiagnosis of AF. Among the erroneous computer ECG interpretations, 17 cases (7.8%) were not corrected by the ordering physicians and/or repeat computer-ECG interpretation; inappropriate follow-up studies or treatments of the patients were undertaken with no serious sequelae. CONCLUSIONS:Erroneous computer ECG interpretation of AF was not rare. Attention should be concentrated on educating physicians about ECG appearance and confounding factors of AF, along with ongoing quality control of built-in software for automatic ECG interpretation.

背景与目标： 背景：本研究的目的是确定通过计算机心电图（ECG）对房颤（AF）进行分析的错误的频率和性质，以及其临床后果。
假设：用于解释心电图的计算机软件已得到改进。
方法：总共收集了10279个心电图，并通过内置的心电图软件​​自动解释，然后由2位心脏病专家重新读取。与AF相关的ECG分为3组：过度解释的AF（除AF以外的其他节奏被解释为AF），误解的AF（AF视为除AF之外的节奏）和真实AF（由计算机ECG解释和心脏病专家解释为AF） 。
结果：409例患者中有1057例与AF相关的心电图。其中，有840个ECG（占79.5％）是真正的AF。 98（9.3％）例发生了过度解释。窦性心律和窦性心动过速伴房性早搏和/或基线假象和窦性心律不齐通常被误​​认为是房颤。心率≤60 bpm和基线伪影显着增加了过度解释房颤的可能性。 119例（11.3％）发生误诊，通常将AF误诊为窦性或室上性心动过速。心动过速和低幅度房性活动的存在显着增加了房颤误诊的可能性。在错误的计算机心电图解释中，有17例（7.8％）没有被订购医生纠正和/或重复进行计算机心电图解释；对患者进行了不适当的随访研究或治疗，没有严重的后遗症。
结论：错误的计算机心电图对房颤的解释并不罕见。应将注意力集中在教育医生有关心电图的出现和房颤的混杂因素，以及用于自动心电图解释的内置软件的持续质量控制方面。

BACKGROUND & AIMS: BACKGROUND:Q waves developed in the subacute and persisting into the chronic phase of myocardial infarction (MI) usually signify myocardial necrosis. However, the mechanism and significance of Q waves that appear very early in the course of acute MI (< 6 h from onset of symptoms), especially if accompanied by ST elevation, are probably different.

HYPOTHESIS:This study assesses the prognostic implications of abnormal Q waves on admission in 2,370 patients with first acute MI treated with thrombolytic therapy < 6 h of onset of symptoms.

RESULTS:Patients with abnormal Q waves in > or = 2 leads with ST-segment elevation (n = 923) were older than patients without early Q waves (n = 1,447) (60.6 +/- 11.9 vs. 58.8 +/- 11.9 years, respectively; p = 0.0003), and had a greater incidence of hypertension (34.3 vs. 30.5%; p = 0.05) and anterior MI (60.6 vs. 41.1%; p < 0.0001). Time from onset of symptoms to therapy was longer in patients with Q waves upon admission (208 +/- 196 vs. 183 +/- 230 min; p = 0.01). Peak serum creatine kinase (2235 +/- 1544 vs. 1622 +/- 1536 IU; p < 0.0001), prevalence of heart failure during hospitalization (13.8 vs. 7.0%, p < 0.0002), hospital mortality (8.0 vs. 4.6%; p = 0.02), and cardiac mortality (6.6 vs. 4.5%, p = 0.11) were higher in patients with anterior MI and with abnormal Q waves than in those without abnormal Q waves upon admission. There was no difference in peak creatine kinase, prevalence of heart failure, in-hospital mortality, and cardiac mortality between patients with and without abnormal Q waves in inferior MI. Multivariate regression analysis confirmed that mortality is independently associated with presence of Q waves on admission (odds ratio 1.61; 95% CI 1.04-2.49; p = 0.04 for all patients; odds ratio 1.65; 95% CI 0.97-2.83; p = 0.09 for anterior wall MI.

CONCLUSION:Abnormal Q waves on the admission electrocardiogram (ECG) are associated with higher peak creatine kinase, higher prevalence of heart failure, and increased mortality in patients with anterior MI. Abnormal Q waves on the admission ECG of patients with inferior MI are not associated with adverse prognosis.

背景与目标： 背景：Q波在亚急性中发展并持续进入心肌梗死（MI）的慢性期，通常预示着心肌坏死。但是，在急性心肌梗死过程中（症状发作后<6小时内）非常早出现的Q波的机制和意义可能不同，尤其是在伴有ST抬高的情况下。

假设：这项研究评估了Q波异常对2370例首次发生溶栓<症状发作后6小时的急性心肌梗死患者入院的预后影响。

结果 ：Q波异常>或= 2导联且ST段抬高的患者（n = 923）比没有早期Q波的患者（n = 1,447）年龄大（分别为60.6 /-11.9 vs. 58.8 /-11.9岁； p = 0.0003），并且高血压的发生率更高（34.3 vs. 30.5％； p = 0.05）和前部MI（60.6 vs. 41.1％; p <0.0001）。入院Q波患者从症状发作到治疗的时间更长（208 /-196对183 /-230分钟； p = 0.01）。血清肌酸激酶峰值（2235 /-1544 vs. 1622 /-1536 IU; p <0.0001），住院期间心力衰竭的患病率（13.8 vs. 7.0％，p <0.0002），住院死亡率（8.0 vs. 4.6％; p = 0.02），并且前MI且Q波异常的患者的心脏死亡率更高（6.6 vs. 4.5％，p = 0.11），高于入院时Q波异常的患者。在有和没有异常MI下Q波的患者中，肌酸激酶的峰值，心力衰竭的患病率，院内死亡率和心源性死亡率无差异。多元回归分析证实，死亡率与入院时Q波的存在独立相关（所有患者的赔率比1.61; 95％CI 1.04-2.49; p = 0.04;比值比1.65; 95％CI 0.97-2.83; p = 0.09前壁心肌梗死

结论：入院心电图（ECG）的Q波异常与较高的肌酸激酶峰值，较高的心衰患病率以及前壁患者死亡率增加相关MI。MI低下患者入院心电图Q波异常与不良预后无关。